Some Drug Side Effects & Contraindictations

Question 1

ACEi side effects:

Answer 1

1. Hypotension
2. Cough
3. Hyperkalemia
4. Acute Renal Failure
5. Fetopathic Potential
6. Skin Rash

Question 2

ARB side effects:

Answer 2

1. Hypotension
2. Hyperkalemia
3. CI in preganancy & breast feeding
   - fetopathic

Question 3

Thiazide & Thiazide-like Diuretics side effects:

Answer 3

(inhibit Na/Cl in DT)

1. Hypokalemia
2. Hyperuricemia
3. Hyperglycemia

Question 4

Loop or High-Ceiling Diuretic side effects:

Answer 4

(inhibit Na/K/2Cl in ascending loop)

1. Hypokalemia, Hyponaturemia, Hypochloremia
2. Dehydration
3. Hyperuricemia
4. Ototoxicity

Question 5

K+ Sparing Diuretics side effects:

Answer 5

(inhibit Na+ in LDT & CD)

hyperkalemia

Question 6

Heparin CI’s:

Answer 6

1. ASA
2. NSAID
3. Dextran
4. Dipyridamole
5. Abciximab
6. Clopidogrel

• inhibit platelet aggregation increase risk of bleeding

7. IV Nitroglycerin

Question 7

Warfarin CI’s:

Answer 7

Drug-Drug interactions:
1. Metronidazole, Macrolides, Fluroquinolones
2. Rifampin
3. Azole Antifungals
4. SSRI
5. Clopidogrel, ASA, NSAIDs
6. Acetaminophen

Drug-Food interactions:
1. Foods rich in Vitamin K (greens)
2. Vitamin K supplements
3. Grapefruit juice
4. Herbal “remedies”

CI in pregnancy (Heparin can be used)
- doesn’t cross breast milk

Question 8

Dabigatran CI’s:

Answer 8

1. Other anticoagulant drugs (Warfarin, Heparin, Rivaroxaban, etc.)
2. Anti-platelet aggregation (Aspirin, NSAIDs, Clopidogrel)
3. CI in pregnancy & breast feeding

Question 9

1st-gen Antihistamine SE’s:

Answer 9

also have antimuscarinic & a adrenergic antagonist activity

sedation, dizziness

Question 10

Climetidine (H2 receptor antagonist) Drug Interactions & SE’s:

Answer 10

Drug interactions (only with it):
1. Carbamazepine
2. Phenytoin
3. Propafenone
4. Warfarin

SE’s (only with it - gynecomastia)
& others: diarrhea, dizziness, rash (mild)

Question 11

PPI’s SE’s & Interactions:

Answer 11

SE’s: Nausea, vomiting, diarrhea, abd. cramping (mild)

Interactions:
1. Azole antifungals
2. Macrolid antibiotics
3. Warfarin
4. Digoxin
5. Benzodiazepine
6. Antacids

Question 12

Fluoroquinolones SE’s:

Answer 12

1. Tendinopathy
2. QT prolongation
3. CNS toxicity
4. Photosensitivity

Question 13

Fluoroquinolones CI’s:

Answer 13

1. Children <16 may produce joint cartilage injury
2. Pregnant or breast-feeding
3. NSAIDs increase CNS toxicity
4. Any drug that prolongs QT interval
5. Warfarin (increased INR)
6. Not taken with Mg, Ca, Al, Fe, or Zn
   - supplements
   - antacids
   - dairy
   - avoid all 1 hr before or 2 hrs after dosing

Question 14

Vancomycin SE’s:

Answer 14

1. Nephrotoxicity
2. Ototoxicity
3. Upper body rash mediated by histamine release

Question 15

Teicoplanin SE’s:

Answer 15

1. Nephrotoxicity

Question 16

Linezolid SE’s:

Answer 16

MANY SERIOUS SE’s that limit its use to situations where other antibiotics cannot be used

1. Myelosuppression: anemia, thrombocytopenia, & neutropenia
2. Peripheral neuropathy, optic neuropathy that may result from inhibition of mitochondrial protein synthesis
3. Inhibits MAO leading to dietary restrictions & CI with pseudoephedrine
4. MAO inhibition may also lead to serotonin syndrome especially with SSRIs

Question 17

Macrolide SE’s & CI’s:

Answer 17

1. Carbamazepine
2. Tacrolimus
3. Warfarin
4. HMG-CoA reductase inhibitors
5. Statins (Lovastatin, Rosuvastatin, Simvastatin)
6. Sotalol, Amiodarone (prolong QT interval)

SE’s:
1. Nausea
2. Vomiting
3. Abd. pain (only erthryo)
4. Diarrhea (much more with erthryo)
5. QT prolongation (avoid if pt has prolonged QT or taking Sotalol or Amidarone)

Question 18

Tetracycline SE’s & CI’s:

Answer 18

SE’s:
Erosions of epithelium
- Esophagus (should take doses with full glass of water & do not lie down for at least a half hr after a dose)
- Photosensitivity

CI’s:
1. Children <12 - understaining of teeth incorportation into bones (damage to cartilage)

2. Pregnant or breast feeding mothers
3. Not absorbed orally very well with Mg, Ca, or Al, Fe, Zn
   - supplements with Ca & Zn
   - Antacids
   - Dairy products
   (avoid all 1 hr before or 2 hrs after dosing)